Recent Industry News

The Department of Health and Human Services (HHS) Office of Inspector General recently submitted its proposed budget for fiscal year (FY) 2018. The $359 million budget includes $291 million to support oversight of the Medicare and Medicaid programs. In justifying its request, the OIG reported expected recoveries of more than $5.66 billion for FY 2016. The recoveries include $4.46 billion in investigative receivables and approximately $82 million in Civil Monetary Penalties (CMPs). Additionally, the OIG reported on its role as a major Health Care Fraud and Abuse Control (HCFAC) program participant. The HCFAC returned five dollars to the Medicare Trust Funds for every one dollar invested in FY 2016.

The OIG reported 844 criminal actions against individuals or organizations that engaged in crimes against HHS programs in FY 2016. In that year, the OIG also reported 708 civil and administrative enforcement actions, including False Claims Act lawsuits filed in federal district courts and CMP law settlements. The OIG also excluded 3,635 individuals and organizations from participation in federal health care programs in FY2016. Additionally, the OIG is part of the Health Care Fraud Strike Force (HCFSF) teams that coordinate operations conducted jointly by federal, state, and local law enforcement entities. The HCFSF’s work resulted in charges against 255 individuals or entities, 207 criminal actions, and $321 million in investigative receivables.

Over the last five years, the OIG’s expected recoveries have averaged $5.3 billion annually. Changes in the amount of expected recoveries from year to year are due to the particular mix of cases resolved in a given year, in addition to continued efforts to work with HHS Operative Divisions to implement OIG recommendations.

The OIG’s Proposed Budget Justifications for Fiscal Year 2018 is available at: